Provider Demographics
NPI:1033470984
Name:INMED CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:INMED CLINICAL SERVICES LLC
Other - Org Name:NORTH SHORE HEALTHCARE ASSOCIATES - FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAWRENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-386-0343
Mailing Address - Street 1:PO BOX 5013
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36103-5013
Mailing Address - Country:US
Mailing Address - Phone:334-386-0343
Mailing Address - Fax:334-386-0382
Practice Address - Street 1:331 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4186
Practice Address - Country:US
Practice Address - Phone:706-782-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INMED CLINICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty